Applicability of the WHO Maternal Near Miss Criteria in a Low-Resource Setting

Nelissen, Ellen; Mduma, Estomih; Broerse, Jacqueline E. W.; Ersdal, Hege; Evjen-Olsen, Bjørg; Roosmalen, Jos van; Stekelenburg, Jelle

doi:10.1371/journal.pone.0061248

Cited by 91 publications

(132 citation statements)

References 21 publications

(39 reference statements)

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“…These determinants are known factors associated with maternal morbidity or mortality (12,16). Mean body mass index and maximum diastolic blood pressure were higher in the potentially life-threatening group, which may be explained by the fact that obesity is a risk factor for high blood pressure and (pre)eclampsia (16,17).…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, case-fatality rates for the study populations in these countries were 3.2% (Brazil), 12% (Malawi) and 13% (Tanzania), which indicates that it is justified to state that all women with SAMM in these countries actually have "life-threatening" conditions. The low detection results were attributed to absence of sophisticated laboratory diagnostics and lack of manpower to perform extensive clinical monitoring in low-income countries (10,12). In the Netherlands, however, such laboratory diagnostics and human resources are available.…”

Section: Discussionmentioning

confidence: 99%

“…The MNM tool applicability was previously studied in single institutions in a variety of settings, including Brazil, Malawi and Tanzania (10)(11)(12). These studies indicate that the MNM tool in general and the organ dysfunction criteria in particular detect only a small proportion of all severe morbidity (Brazil 12%, Malawi 22%, Tanzania 42%).…”

Section: Key Messagementioning

confidence: 95%

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Validating the WHO Maternal Near Miss Tool in a high‐income country

Witteveen

Koning

Bezstarosti

et al. 2015

Acta Obstet Gynecol Scand

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Introduction. This study was performed to assess the applicability of the WHO Maternal Near Miss Tool (MNM Tool) and the organ dysfunction criteria in a high-income country. Material and methods. The MNM tool was applied to 2552 women who died of pregnancy-related causes or sustained severe acute maternal morbidity between August 2004 and August 2006 in one of the 98 hospitals with a maternity unit in the Netherlands. Fourteen (0.6%) cases had insufficient data for application. Each case was assessed according to the three main "MNM categories" specified in the MNM tool and their subcategory criteria: five disease-, four intervention-and seven organ dysfunction-based criteria. Potentially life-threatening conditions (disease-based inclusions) and lifethreatening cases (organ dysfunction-based inclusions) were differentiated according to WHO methodology. Outcomes were incidence of all (sub)categories and case-fatality rates. Results. Of the 2538 cases, 2308 (90.9%) women fulfilled disease-based, 2116 (83.4%) intervention-based and 1024 (40.3%) organ dysfunction-based criteria. Maternal death occurred in 48 women, of whom 23 (47.9%) fulfilled disease-based, 33 (68.8%) intervention-based and 31 (64.6%) organ dysfunction-based criteria. Case-fatality rates were 23/2308 (1.0%) for cases fulfilling the disease-based criteria, 33/2116 (1.6%) for intervention-based criteria and 31/1024 (3.0%) for women fulfilling the organ dysfunction-based criteria. Conclusions. In the Netherlands, where advanced laboratory and clinical monitoring are available, organ dysfunction-based criteria of the MNM tool failed to identify nearly two-thirds of sustained severe acute maternal morbidity cases and more than one-third of maternal deaths. Disease-based criteria remain important, and using only organ dysfunctionbased criteria would lead to underestimating severe acute maternal morbidity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Key Messagementioning

confidence: 95%

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Validating the WHO Maternal Near Miss Tool in a high‐income country

Witteveen

Koning

Bezstarosti

et al. 2015

Acta Obstet Gynecol Scand

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“…The threshold of five units of blood for identification of MNM according to WHO criteria led to underreporting of MNM in a low resource setting. 4 Five factor scoring system uses 3 units of threshold of blood with specificity of 93.9%. 5 The objective of this study was to evaluate the associated risk factors and determinants of near miss obstetric cases at B.P.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of associated risk factors of near miss obstetrics cases at B.P. Koirala Institute of Health Sciences, Dharan, Nepal

Khadka¹,

Uprety²,

Rai³

2018

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONWorldwide, more than half a million women between age 15-49 die each year from the complication of pregnancy and childbirth.1 Near misses have emerged as a useful complement to the investigation of maternal deaths. 2Near miss is defined as "A woman who nearly died but survived a complication that occurred during pregnancy, childbirth, or within 42 days of termination pregnancy. 2,3The patient survived either by chance or because of hospital care she received." Currently we have high pregnancy related mortality ratio (247 deaths due to any causes in pregnancy up to six weeks after pregnancy event per 100 thousand live births) and maternal mortality ratio (229 deaths due to pregnancy and childbirth related cause per 100 thousand live births) which constitutes 11% of deaths of women of reproductive age group.Various associated risk factors contribute to near miss events. Commonly seen in our context are: Antepartum/Postpartum hemorrhage, complication of abortion, ruptured ectopic and ruptured uterus, Hypertension complicating pregnancy: severe preeclampsia, eclampsia, sepsis or severe systemic ABSTRACT Background: In 2011, around 273,465 women died worldwide during pregnancy, childbirth or within 42 days after childbirth. Near-miss is recognized as the predictor of level of care and maternal death. The objective of the study was to evaluate the associated risk factors of near miss obstetric cases. Methods: A prospective observational study was done from August 1, 2014 to July 30, 2015 in Department of Obstetrics and Gynecology at BPKIHS hospital, tertiary care hospital in Eastern Nepal, Dharan. Case eligible by 5 factor scoring system and WHO near miss criteria were evaluated. Risk factors included severe hemorrhage, hypertensive disorders, complication of abortion, ruptured uterus, medical/surgical condition and sepsis. Results: A total of 9,727 delivery were attended during the study period from August 2014 to July 2014. There were 6307 (71.5%) vaginal delivery and 2777 (28.5%) caesarean section and 181 perinatal death with total of 9,546 livebirth. 162 near miss and 16 maternal death occurred during the study. Maternal near miss rate of 16.6 per 1000 live birth, Women with life-threatening conditions of 172, Severe maternal outcome ratio of 18.64, Maternal nearmiss: mortality ratio: 10.1:1, Mortality index: 8.98%. Risk factors were obstetric hemorrhage 27.8%, abortion/ectopic 27.2%, eclampsia 16%, medical/surgical condition 14.8%, sepsis 13.6%, severe preeclamsia 11.1%, ruptured uterus 3.1%, and molar pregnancy 1.9% and cardiovascular and coagulation dysfunction as a major life-threatening condition and sepsis (25%) was the major cause of mortality. Conclusions: Haemorrhage and hypertensive disorders are the leading causes of near miss event. Evaluation of associated risk factor can be potential tool for reduction of maternal morbity and mortality.

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“…Entende-se a relevância de debates acerca da saúde durante a gestação como possibilidades concretas de se reorientar o manejo da atenção à saúde da mulher e incorporar as diretrizes que preconizam qualidade e segurança à saúde da mulher no ciclo gravídico-puerperal, tendo como foco o enfrentamento da mortalidade materna, um dos objetivos do milênio, que não se encontra contemplado em vários países (1) . Nessa construção propositiva, a Organização Mundial da Saúde (OMS) estima que, em 2010, 287 mil mulheres no mundo morreram durante a gestação e o parto.…”

Section: Introductionunclassified